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Gui Y, Lin Y, Wu H, Dai G, Liang X, Chu C, Zheng Y, Zhao Q, Wang F, Sun S, Huang G, Yan W, He L, Liu F. Diagnostic Value of 99mTc-MIBI Myocardial Perfusion Imaging in Detecting Myocardial Ischemia of Children with Kawasaki Disease and Coronary Artery Lesions. Pediatr Cardiol 2024:10.1007/s00246-024-03545-2. [PMID: 38940825 DOI: 10.1007/s00246-024-03545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
Pediatric patients with coronary artery lesions (CALs) after Kawasaki disease (KD) may be complicated with myocardial ischemia. Although previous studies in adults have proven the diagnostic value of 99mTc-MIBI myocardial perfusion imaging (MPI) for ischemic heart disease, its feasibility and accuracy in this pediatric population remain uncertain. In this retrospective study, we collected data of 177 pediatric patients (Age range: 6 months to 14 years) who had undergone MPI and coronary artery angiography (CAG) between July 2019 and February 2023. Using the positive result of CAG as the reference standard of myocardial ischemia, we compared the results of 99mTc-MIBI MPI with other non-invasive examinations, including cardiac magnetic resonance imaging (CMRI), echocardiogram, and comprehensive electrocardiogram-related examinations. All patients finished adenosine triphosphate stress MPI without major side effects. The sensitivity of MPI was 79.17%, which was greater than CMRI and echocardiogram (P < 0.05). The negative predictive value and the accuracy of MPI were 89.9% and 71.75%, indicating the advantages over others. Composite monitoring strategy of MPI and CMRI effectively improved the diagnostic performance (P < 0.001). In 4 cases diagnosed with myocardial ischemia by "MPI + CMRI," despite the absence of significant stenosis, multiple giant coronary artery aneurysms (GCAA) were all observed in CAG. 99mTc-MIBI MPI is the preferred non-invasive examination for detecting myocardial ischemia in pediatric patients with CAL after KD. When combined with CMRI, it can enhance diagnostic accuracy. Multiple GCAAs without stenosis may be an isolated risk factor of myocardial ischemia.
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Affiliation(s)
- Yiting Gui
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yixiang Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Ha Wu
- Nuclear Medicine Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guangan Dai
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xuecun Liang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Chen Chu
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanzheng Zheng
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Quming Zhao
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Feng Wang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Shuna Sun
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guoying Huang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Lan He
- Heart Center, Children's Hospital of Fudan University, Shanghai, China.
| | - Fang Liu
- Heart Center, Children's Hospital of Fudan University, Shanghai, China.
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Chen X, Gao L, Zhen Z, Wang Y, Na J, Yu W, Tian Z, Yuan Y, Qian S. Incidence of coronary artery lesions in children with recurrent Kawasaki disease. Expert Rev Clin Immunol 2024; 20:673-678. [PMID: 38315096 DOI: 10.1080/1744666x.2024.2314213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Coronary artery lesions (CALs) are a major complication of Kawasaki disease (KD); however, data on CAL incidence and risk factors in recurrent KD are limited. METHODS Ninety-seven children with recurrent KD were retrospectively enrolled from 2013 to 2022, and CAL incidence was tracked during admission, discharge, and during follow-up. RESULTS Initially, 27.8% had CAL at admission and discharge, declining to 7.2% at 12 months post-discharge. Most patients (66 of 97, 68.0%) did not exhibit CAL at any of the time points, 7 cases presented CAL at all time points, indicating a persistent CAL. The remaining 20 cases presented CAL at admission but recovered at discharge or during follow-up. Notably, transient CALs had presented at discharge, or during the follow-up, but finally resolved at 12 months after discharge. Notably, prior IVIG resistance and increased prothrombin time seemed associated with CAL in recurrent KD, suggesting they could help identify patients needing close monitoring. CONCLUSION The study highlights decreasing CAL incidence over time in recurrent KD but with diverse patterns, emphasizing the importance of monitoring and further investigations to confirm these findings.
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Affiliation(s)
- Xi Chen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lu Gao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Wang
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jia Na
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wen Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyu Tian
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Zhang H, Jiao F, Wang J, Xu C, Zhang K. The effect of vitamin D status on the occurrence of Kawasaki Disease: a meta-analysis. BMC Pediatr 2024; 24:287. [PMID: 38684993 PMCID: PMC11057174 DOI: 10.1186/s12887-024-04768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
AIM The relationship between vitamin D status and Kawasaki Disease (KD), as well as coronary artery lesion (CAL), has yet to be established. METHODS A meta-analysis was conducted to assess the correlation between vitamin D status and KD, as well as the impact of vitamin D status on the progression of KD into CAL. RESULTS The meta-analysis revealed a consistent and significant association between serum 25(OH)D level and the occurrence KD (studies N = 22; z = -3.51, P < 0.001). Patients with KD had markedly lower levels of vitamin D than healthy controls (SMD: -1.30 ng/mL, 95%CI: -2.05 to -0.55 ng/mL). CONCLUSION The study provided evidence supporting a significant association between lower serum vitamin D levels and the occurrence of KD, particularly within the Chinese population. However, the findings did not suggest a direct impact of vitamin D on the development of CAL in KD patients.
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Affiliation(s)
- Haixiang Zhang
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, 256# Youyi West Road, Xi'an, Shaanxi, 710068, China
- Shaanxi Engineering Research Center of Cell Immunology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Fuyong Jiao
- Shaanxi Provincial Kawasaki Disease Treatment Center/Children's Hospital of Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Jiaojiao Wang
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, 256# Youyi West Road, Xi'an, Shaanxi, 710068, China
- Department of Medicine, School of Medicine, Yan'an University, Yan'an, 716000, China
| | - Cuixiang Xu
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, 256# Youyi West Road, Xi'an, Shaanxi, 710068, China.
- Shaanxi Engineering Research Center of Cell Immunology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
| | - Kejin Zhang
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, 256# Youyi West Road, Xi'an, Shaanxi, 710068, China.
- Department of Biological Sciences, College of Life Science, Institute of Population and Health, Northwest University, Xi'an, 710069, China.
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Celis-Seposo AK, Madaniyazi L, Seposo X, Hashizume M, Yoshida LM, Toizumi M. Incidence and seasonality of Kawasaki disease in children in the Philippines, and its association with ambient air temperature. Front Pediatr 2024; 12:1358638. [PMID: 38711494 PMCID: PMC11070490 DOI: 10.3389/fped.2024.1358638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite an unknown cause, Kawasaki disease (KD) is currently the primary leading cause of acquired heart disease in developed countries in children and has been increasing in recent years. Research efforts have explored environmental factors related to KD, but they are still unclear especially in the tropics. We aimed to describe the incidence of KD in children, assess its seasonality, and determine its association with ambient air temperature in the National Capital Region (NCR), Philippines from January 2009 to December 2019. Methods Monthly number of KD cases from the Philippine Pediatric Society (PPS) disease registry was collected to determine the incidence of KD. A generalized linear model (GLM) with quasi-Poisson regression was utilized to assess the seasonality of KD and determine its association with ambient air temperature after adjusting for the relevant confounders. Results The majority of KD cases (68.52%) occurred in children less than five years old, with incidence rates ranging from 14.98 to 23.20 cases per 100,000 population, and a male-to-female ratio of 1.43:1. Seasonal variation followed a unimodal shape with a rate ratio of 1.13 from the average, peaking in March and reaching the lowest in September. After adjusting for seasonality and long-term trend, every one-degree Celsius increase in the monthly mean temperature significantly increased the risk of developing KD by 8.28% (95% CI: 2.12%, 14.80%). Season-specific analysis revealed a positive association during the dry season (RR: 1.06, 95% CI: 1.01, 1.11), whereas no evidence of association was found during the wet season (RR: 1.10, 95% CI: 0.95, 1.27). Conclusion We have presented the incidence of KD in the Philippines which is relatively varied from its neighboring countries. The unimodal seasonality of KD and its linear association with temperature, independent of season and secular trend, especially during dry season, may provide insights into its etiology and may support enhanced KD detection efforts in the country.
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Affiliation(s)
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Xerxes Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Ateneo de Manila University, Pasig, Philippines
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lay Myint Yoshida
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Tang Y, Liu Y, Du Z, Wang Z, Pan S. Prediction of coronary artery lesions in children with Kawasaki syndrome based on machine learning. BMC Pediatr 2024; 24:158. [PMID: 38443868 PMCID: PMC10916227 DOI: 10.1186/s12887-024-04608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Kawasaki syndrome (KS) is an acute vasculitis that affects children < 5 years of age and leads to coronary artery lesions (CAL) in about 20-25% of untreated cases. Machine learning (ML) is a branch of artificial intelligence (AI) that integrates complex data sets on a large scale and uses huge data to predict future events. The purpose of the present study was to use ML to present the model for early risk assessment of CAL in children with KS by different algorithms. METHODS A total of 158 children were enrolled from Women and Children's Hospital, Qingdao University, and divided into 70-30% as the training sets and the test sets for modeling and validation studies. There are several classifiers are constructed for models including the random forest (RF), the logistic regression (LR), and the eXtreme Gradient Boosting (XGBoost). Data preprocessing is analyzed before applying the classifiers to modeling. To avoid the problem of overfitting, the 5-fold cross validation method was used throughout all the data. RESULTS The area under the curve (AUC) of the RF model was 0.925 according to the validation of the test set. The average accuracy was 0.930 (95% CI, 0.905 to 0.956). The AUC of the LG model was 0.888 and the average accuracy was 0.893 (95% CI, 0,837 to 0.950). The AUC of the XGBoost model was 0.879 and the average accuracy was 0.935 (95% CI, 0.891 to 0.980). CONCLUSION The RF algorithm was used in the present study to construct a prediction model for CAL effectively, with an accuracy of 0.930 and AUC of 0.925. The novel model established by ML may help guide clinicians in the initial decision to make a more aggressive initial anti-inflammatory therapy. Due to the limitations of external validation and regional population characteristics, additional research is required to initiate a further application in the clinic.
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Affiliation(s)
- Yaqi Tang
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Yuhai Liu
- Dawning International Information Industry Co., Ltd., No. 78 Zhuzhou Road, Laoshan District, Qingdao, China
- Sugon Nanjing Institute, Co., Ltd., No. 519 Chengxin Avenue, Fangyuan Road, Jiangning District, Nanjing, China
| | - Zhanhui Du
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Zheqi Wang
- School of Mathematics, Jilin University, Changchun, China
| | - Silin Pan
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
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Xu D, Chen YS, Feng CH, Cao AM, Li XH. Development of a prediction model for progression of coronary artery lesions in Kawasaki disease. Pediatr Res 2024; 95:1041-1050. [PMID: 38040988 DOI: 10.1038/s41390-023-02931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUNDS This study aimed to identify risk factors for the progression of coronary artery lesions (CALs) in children with Kawasaki disease (KD) and to develop a nomogram prediction model. METHODS This is a retrospective case-control study in which the participants were categorized into three groups based on the changes of the maximum Z score (Zmax) of coronary arteries at the 1-month follow-up compared with the baseline Zmax: CALs-progressed, CALs-improved, and CALs-unchanged. RESULTS Of total 387 patients, 65 (27%), 319 (73%), and 3 (0.7%) patients were categorized into CALs-progressed group, CALs-improved group, and CALs-unchanged group, respectively. Six independent factors associated with CALs progression were identified, including initial IVIG resistance, baseline Zmax, the number of coronary arteries involved, C-reactive protein, albumin, and soluble interleukin-2 receptor (odds ratio: 7.19, 1.51, 2.32, 1.52, 0.86, and 1.46, respectively; all P-values < 0.01). The nomogram prediction model including these six independent risk factors yielded an area under the curve (AUC) of 0.80 (95% confidence interval, 0.74 to 0.86). The accuracy of this model reached 81.7% after the Monte-Carlo Bootstrapping 1000 repetitions. CONCLUSIONS The nomogram prediction model can identify children at high risk for the progression of CALs at early stages. IMPACT Six independent factors associated with CALs progression were identified, including initial IVIG resistance, baseline Zmax, the number of coronary arteries involved, CRP, ALB, and sIL-2R. The prediction model we constructed can identify children at high risk for the progression of CALs at early stages and help clinicians make individualized treatment plans. Prospective, multi-centered studies with larger sample sizes are warranted to validate the power of this prediction model in children with KD.
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Affiliation(s)
- Dan Xu
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ye-Shi Chen
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Chen-Hui Feng
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Ai-Mei Cao
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Xiao-Hui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
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Liao JW, Guo X, Li XX, Xian JM, Chen C, Xu MG. Exploring the diagnostic value of CLR and CPR in differentiating Kawasaki disease from other infectious diseases based on clinical predictive modeling. Front Pediatr 2024; 12:1345141. [PMID: 38434730 PMCID: PMC10904529 DOI: 10.3389/fped.2024.1345141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background Kawasaki disease (KD) is an important cause of acquired heart disease in children and adolescents worldwide. KD and infectious diseases can be easily confused when the clinical presentation is inadequate or atypical, leading to misdiagnosis or underdiagnosis of KD. In turn, misdiagnosis or underdiagnosis of KD can lead to delayed use of intravenous immunoglobulin (IVIG), increasing the risk of drug resistance and coronary artery lesions (CAL). Objectives The purpose of this study was to develop a predictive model for identifying KD and infectious diseases in children in the hope of helping pediatricians develop timely and accurate treatment plans. Methods The data Patients diagnosed with KD from January 2018 to July 2022 in Shenzhen Longgang District Maternity & Child Healthcare Hospital, and children diagnosed with infectious diseases in the same period will be included in this study as controls. We collected demographic information, clinical presentation, and laboratory data on KD before receiving IVIG treatment. All statistical analyses were performed using R-4.2.1 (https://www.rproject.org/). Logistic regression and Least Absolute Shrinkage with Selection Operator (LASSO) regression analyses were used to build predictive models. Calibration curves and C-index were used to validate the accuracy of the prediction models. Results A total of 1,377 children were enrolled in this study, 187 patients with KD were included in the KD group and 1,190 children with infectious diseases were included in the infected group. We identified 15 variables as independent risk factors for KD by LASSO analysis. Then by logistic regression we identified 7 variables for the construction of nomogram including white blood cell (WBC), Monocyte (MO), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), albumin (ALB), C-reactive protein to procalcitonin ratio (CPR) and C-reactive protein to lymphocyte ratio (CLR). The calibration curve and C-index of 0.969 (95% confidence interval: 0.960-0.978) validated the model accuracy. Conclusion Our predictive model can be used to discriminate KD from infectious diseases. Using this predictive model, it may be possible to provide an early determination of the use of IVIG and the application of antibiotics as soon as possible.
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Affiliation(s)
- Jin-Wen Liao
- The Department of Pediatrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong Province, China
| | - Xin Guo
- Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong Province, China
| | - Xu-Xia Li
- The Department of Pediatrics, Third People’s Hospital of Longgang District Shenzhen, Shenzhen, Guangdong Province, China
| | - Jia-Ming Xian
- Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong Province, China
| | - Cheng Chen
- Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong Province, China
| | - Ming-Guo Xu
- The Department of Pediatrics, Third People’s Hospital of Longgang District Shenzhen, Shenzhen, Guangdong Province, China
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Geng R, Yu M, Xu J, Wei Y, Wang Q, Chen J, Sun F, Xu K, Xu H, Liu X, Xiao J, Zhang X, Xie B. Amino acids analysis reveals serum methionine contributes to diagnosis of the Kawasaki disease in mice and children. J Pharm Biomed Anal 2024; 239:115873. [PMID: 38008045 DOI: 10.1016/j.jpba.2023.115873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Kawasaki disease (KD) patients often lack early and definitive diagnosis due to insufficient clinical criteria, whereas biomarkers might accelerate the diagnostic process and treatment. METHODS The KD mouse models were established and thirteen amino acids were determined. A total of 551 serum samples were collected including KD patients (n = 134), HCs (n = 223) and KD patients after intravascular immunoglobulin therapy (IVIG, n = 194). A paired analysis of pre- and post-IVIG was employed in 10 KD patients. RESULTS The pathological alterations of the aorta, myocardial interstitium and coronary artery vessel were observed in KD mice; the serum levels of methionine in KD mice (n = 40) were markedly altered and negatively correlated with the C-reactive protein levels. Consistent with the mouse model, serum methionine were significantly decreased in KD children, with the relative variation ratio of KD with HCs above 30% and AUROC value of 0.845. Serum methionine were correlated with Z-Score and significantly restored to the normal ranges after KD patient IVIG treatment. Another case-control study with 10 KD patients with IVIG sensitivity and 20 healthy controls validated serum methionine as a biomarker for KD patients with AUROC of 0.86. Elevation of serum DNMT1 activities, but no differences of DNMT3a and DNMT3b, were observed in KD patients when comparing with those in the HCs. CONCLUSIONS Our study validated that serum methionine was a potential biomarker for KD, the alteration of which is associated with the activation of DNMT1 in KD patients.
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Affiliation(s)
- Ruijin Geng
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China; School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China
| | - Mengjie Yu
- School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China
| | - Jinbiao Xu
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
| | - Yuanwang Wei
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
| | - Qiong Wang
- Department of Pediatrics, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Junguo Chen
- Department of Pediatrics, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Fei Sun
- Department of Pediatrics, the Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Kun Xu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Han Xu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Xiaohui Liu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Juhua Xiao
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang 330001, China.
| | - Xianchao Zhang
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China.
| | - Baogang Xie
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China; School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China.
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Zhu Y, Chen R, Liu C, Niu Y, Meng X, Shi S, Yu K, Huang G, Xie L, Lin S, Huang M, Huang M, Chen S, Kan H, Liu F, Chu C. Short-term exposure to ozone may trigger the onset of Kawasaki disease: An individual-level, case-crossover study in East China. CHEMOSPHERE 2024; 349:140828. [PMID: 38040257 DOI: 10.1016/j.chemosphere.2023.140828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023]
Abstract
Kawasaki disease (KD) is an acute, systemic vasculitis that primarily affects children aged under the age of 5. While environmental factors have been linked to the development of KD, the specific role of ozone (O3) pollution in triggering the disease onset remains uncertain. This study aimed to examine the associations between short-term O3 exposure and KD onset in children. Utilizing a satellite-based model with a spatial resolution of 1 × 1 km, we matched 1808 KD patients (out of a total of 6115 eligible individuals) to pre-onset ozone exposures based on their home addresses in East China between 2013 and 2020. Our findings revealed a significant association of O3 exposure with KD onset on the day of onset (lag 0 day). However, this association attenuated and became statistically insignificant on lag 1 and lag 2 days. Each interquartile range (52.32 μg/m3) increase in O3 concentration at lag 0 day was associated with a 16.2% (95% CI: 3.6%, 30.3%) increased risk of KD onset. The E-R curve for O3 exhibited a plateau at low concentrations and then increased rapidly at concentrations ≥75 μg/m3. Notably, these associations were stronger in male children, younger children (<2 years of age) and patients experiencing KD onset during the warm season. This study provides novel epidemiological evidence indicating that short-term O3 exposure is associated with an increased risk of childhood KD onset. These findings emphasized the importance of considering this environmental risk factor in KD prevention strategies.
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Affiliation(s)
- Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yue Niu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Su Shi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Kexin Yu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Guoying Huang
- Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Liping Xie
- Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Siyuan Lin
- Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Meirong Huang
- Pediatric Heart Center, Shanghai Children's Medical Center, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China
| | - Fang Liu
- Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Chen Chu
- Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Shanghai, 201102, China.
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Yang P, Zhang J, Liu Y, Feng S, Yi Q. Prediction of Coronary Artery Lesions in Patients With Recurrent Kawasaki Disease. Pediatr Infect Dis J 2024; 43:101-108. [PMID: 37922481 DOI: 10.1097/inf.0000000000004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND A subset of patients with Kawasaki disease (KD) will suffer recurrence. However, there is still a lack of accurate prediction models for coronary artery lesions (CAL) in recurrent KD patients. It is necessary to establish a new nomogram model for predicting CAL in patients with recurrent KD. METHODS Data from patients with recurrent KD between 2015 and 2021 were retrospectively reviewed. After splitting the patients into training and validation cohorts, the least absolute shrinkage and selection operator was used to select the predictors of CAL and multivariate logistic regression was used to construct a nomogram based on the selected predictors. The application of area under the receiver operating characteristic curve (AUC), calibration curves, Hosmer-Lemeshow test, Brier score and decision curve analysis were used to assess the model performance. RESULTS A total of 159 recurrent KD patients were enrolled, 66 (41.5%) of whom had CAL. Hemoglobin levels, CAL at the first episode, and intravenous immunoglobulin resistance at recurrence were identified by the least absolute shrinkage and selection operator regression analysis as significant predictors. The model incorporating these predictors showed good discrimination (AUC, 0.777) and calibration capacities (Hosmer-Lemeshow P value, 0.418; Brier score, 0.190) in the training cohort. Application of the model to the validation cohort yielded an AUC of 0.741, a Hosmer-Lemeshow P value of 0.623 and a Brier score of 0.190. The decision curve analysis demonstrated that the nomogram model was clinically useful. CONCLUSIONS The proposed nomogram model could help clinicians assess the risk of CAL in patients with recurrent KD.
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Affiliation(s)
- Penghui Yang
- From the Department of Cardiovascular Medicine
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Zhang
- From the Department of Cardiovascular Medicine
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yihao Liu
- From the Department of Cardiovascular Medicine
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Siqi Feng
- From the Department of Cardiovascular Medicine
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qijian Yi
- From the Department of Cardiovascular Medicine
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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11
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Zhang J, Yang P, Liu Y, Chen Z, Wu J, Feng S, Yi Q. Serum levels of PDGF-CC as a potential biomarker for the diagnosis of Kawasaki disease. Ital J Pediatr 2024; 50:16. [PMID: 38273388 PMCID: PMC10809580 DOI: 10.1186/s13052-024-01580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that predominantly affects children, and no specific diagnostic biomarkers for KD are available. Platelet-derived growth factor CC (PDGF-CC) is a peptide with angiogenic properties that has been amply demonstrated to play a critical role in the cardiovascular system. This study aimed to investigate the serum expression of PDGF-CC in children with KD and to evaluate the ability of PDGF-CC to diagnose KD. METHODS A total of 96 subjects, including 59 KD patients, 17 febrile controls (FC), and 20 healthy controls (HC), were enrolled. Serum levels of PDGF-CC were measured via enzyme-linked immunosorbent assay. The associations between PDGF-CC and clinical laboratory parameters were investigated by correlation analysis. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS Serum PDGF-CC levels in the KD group were significantly higher than in the FC and HC groups. Serum PDGF-CC levels in the KD group were positively correlated with white blood cell counts, percentage of neutrophils, IL-2, IL-12p70, TNF-α, and IL-1β levels, and negatively correlated with the percentage of lymphocytes. In the analysis of ROC curves, the area under the curve was 0.796 (95% confidence interval 0.688-0.880; P < 0.0001) for PDGF-CC and increased to 0.900 (95% confidence interval 0.808-0.957; P < 0.0001) in combination with white blood cell counts and C-reactive protein. CONCLUSIONS PDGF-CC is a potential biomarker for KD diagnosis, and the combination with white blood cell counts and C-reactive protein can further improve diagnostic performance.
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Affiliation(s)
- Jing Zhang
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Penghui Yang
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Yihao Liu
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Zhuo Chen
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Jinhui Wu
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Siqi Feng
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China.
| | - Qijian Yi
- Department of Cardiovascular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, National Clinical Key Cardiovascular Specialty, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China.
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12
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Jiang S, Li M, Xu K, Xie Y, Liang P, Liu C, Su Q, Li B. Predictive factors of medium-giant coronary artery aneurysms in Kawasaki disease. Pediatr Res 2024; 95:267-274. [PMID: 37670043 PMCID: PMC10798897 DOI: 10.1038/s41390-023-02798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND We aimed to examine predictive measures for medium and giant coronary artery aneurysms (CAA) in Kawasaki disease (KD) patients. METHODS Patients who were diagnosed with KD from 2015 to 2021 were retrospectively reviewed. The clinical and laboratory data were compared between medium-giant group and non-medium-giant group. RESULTS A total of 1331 KD patients were investigated, of whom 63 patients (4.7%) developed medium-giant CAA including 27 patients (2%) with giant CAA. Sex, age, fever duration, intravenous immunoglobulin (IVIG) resistance, platelet count, and albumin level independently predicted medium or giant CAA by multivariate logistic regression analysis. Male, age, duration of fever, IVIG resistance, platelet count, hemoglobin, and erythrocyte sedimentation rate were independent predictors for giant CAA. The two new scoring systems using these factors in identifying patients with medium-giant CAA and giant CAA had respectively sensitivities of 86.89% and 92.59%, and specificities of 81.65% and 87.93%. Validation in 2021 dataset (193 KD patients) showed comparable sensitivity and specificity to development dataset. CONCLUSIONS Male, age, fever duration, IVIG resistance, platelet count, albumin, hemoglobin, and erythrocyte sedimentation rate might be significant predictors of medium and giant CAA. The sensitivity and specificity in our risk prediction model were higher than in previous research. IMPACT This is the first study to search for risk factors and establish a prediction model for the development of medium-giant CAA in the Chinese population using z-scores and absolute inner diameter values based on large sample sizes. The sensitivity and specificity in our model were higher than in previous studies. Our research could help clinicians better predict medium-giant CAA and choose more appropriate treatment.
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Affiliation(s)
- Saitong Jiang
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Meng Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Kun Xu
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Ying Xie
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Piaohong Liang
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Cong Liu
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qiru Su
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Boning Li
- Department of Cardiology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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13
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Wang W, Zhu L, Li X, Liu Z, Lv H, Qian G. Emerging evidence of microbial infection in causing systematic immune vasculitis in Kawasaki disease. Front Microbiol 2023; 14:1313838. [PMID: 38188572 PMCID: PMC10771848 DOI: 10.3389/fmicb.2023.1313838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Kawasaki disease (KD) is a systematic vasculitis that is often complicated by coronary artery lesions and is a leading cause of acquired heart disease in developed countries. Previous studies have suggested that genetic susceptibility, together with an inducing infectious agent, could be involved in KD pathogenesis; however, the precise causative agent of this disease remains unknown. Moreover, there are still debates concerning whether KD is an infectious disease or an autoimmune disease, although many studies have begun to show that various pathogens functioning as critical inducers could activate different kinds of immune cells, consequently leading to the dysfunction of endothelial cells and systematic vasculitis. Here in this review, we attempt to summarize all the available evidence concerning pathogen infections associated with KD pathogenesis. We also discuss the related mechanisms, present a future perspective, and identify the open questions that remain to be investigated, thereby providing a comprehensive description of pathogen infections and their correlations with the host immune system in leading to KD.
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Affiliation(s)
- Wang Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Liyan Zhu
- Department of Experimental Center, Medical College of Soochow University, Suzhou, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiheng Liu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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14
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Zhou Y, Wu Y, Yuan C, Yin W, Wang B, Ding Y. The expression of autophagy markers in IVIG-resistant Kawasaki disease and the establishment of prediction model. BMC Pediatr 2023; 23:642. [PMID: 38114939 PMCID: PMC10729374 DOI: 10.1186/s12887-023-04386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The aim of this study was to find early predictors of Intravenous Immunoglobulin (IVIG)-Resistant Kawasaki Disease. METHODS Patients diagnosed with Kawasaki disease were enrolled in this study. Univariate analysis and multiple logistic regression were used to analyze the clinical characteristics and laboratory findings of patients in both groups before IVIG treatment. Independent predictors of Intravenous Immunoglobulin-Resistant Kawasaki Disease were analyzed, and a prediction model for children with Intravenous Immunoglobulin-Resistant Kawasaki Disease was constructed. RESULTS A total of 108 children (67 males and 41 females) with IVIG-sensitive Kawasaki disease and 31 children (20 males and 11 females) with IVIG-resistant Kawasaki disease participated in this study. Compared with the IVIG-sensitive group, the duration of hospitalization, ALT, AST, GLB, r-GT, IgG, PCT, and ESR was elevated in the IVIG-resistant KD group, and ATG16L1, LC3II, BECN1, RBC, HGB, ALB, A/G, and CK were significantly lower (P < 0.05). mRNA expression of ESR, BECN1, and LC3II were independent risk factors for IVIG-resistant Kawasaki disease. A logistic regression model and scoring system were established, and the cut-off values of independent risk factors were derived from ROC curves: ESR ≥ 79.5 mm/h, BECN1 ≤ 0.645, LC3II ≤ 0.481. A new scoring system was established according to the respective regression coefficients as follows: ESR ≥ 79.5 mm/h (1 point), BECN1 ≤ 0.645 (1 point). LC3II ≤ 0.481 (2 points), 0-1 as low risk for IVIG non-response, and ≥ 2 as high risk. Applied to this group of study subjects, the sensitivity was 87.10%, specificity 83.33%, Youden index 0.70, AUC 0.9. CONCLUSIONS Autophagy markers ATG16L1, BECN1, and LC3II are down-regulated in the expression of IVIG -resistant KD. ESR, BECN1, and LC3II mRNAs are independent risk factors for IVIG-resistant KD and may be involved in the development of IVIG-resistant KD. This study established a new model that can be used to predict IVIG-resistant KD, and future validation in a larger population is needed.
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Affiliation(s)
- Yang Zhou
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Yali Wu
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Chunhui Yuan
- Department of Laboratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Wei Yin
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Baoxiang Wang
- Department of Digestive System, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
| | - Yan Ding
- Department of Immunology and Infectious Diseases, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
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15
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李 燕, 袁 晨, 蔡 艾, 周 博, 黄 腾. [Platelet-to-lymphocyte ratio as a biomarker for predicting coronary artery lesions in Chinese children with Kawasaki disease: a Meta analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1219-1226. [PMID: 38112138 PMCID: PMC10731965 DOI: 10.7499/j.issn.1008-8830.2306097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To systematically evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting coronary artery lesions (CAL) in Chinese children with Kawasaki Disease (KD). METHODS A comprehensive search was conducted in databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database from inception to December 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale, and a Meta analysis was performed using Stata 15.1. RESULTS A total of ten published reports, involving 3 664 Chinese children with KD, were included in this Meta analysis, of whom 1 328 developed CAL. The Meta analysis revealed a sensitivity of 0.78 (95%CI: 0.71-0.83), specificity of 0.71 (95%CI: 0.61-0.80), overall diagnostic odds ratio of 8.69 (95%CI: 5.02-15.06), and an area under the curve of the summary receiver operating characteristic of 0.82 (95%CI: 0.78-0.85) for PLR in predicting CAL in the children with KD. The sensitivity, specificity, and area under the curve of summary receiver operating characteristic were lower for PLR alone compared to PLR in combination with other indicators. Sensitivity analysis demonstrated the stability of the Meta analysis results with no significant changes upon excluding individual studies. However, a significant publication bias was observed (P<0.001). CONCLUSIONS PLR demonstrates certain predictive value for CAL in Chinese children with KD.
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Chen J, Li J, Yue Y, Liu Y, Xie T, Peng J, Deng Z, Cao Y. Nomogram for predicting coronary artery lesions in patients with Kawasaki disease. Clin Cardiol 2023; 46:1434-1441. [PMID: 37540643 PMCID: PMC10642325 DOI: 10.1002/clc.24113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Coronary artery lesions are the most important complications of Kawasaki disease. Approximately 25-30% of untreated patients develop coronary artery disease, which can lead to long-term cardiovascular sequelae. AIM The aim of this study is to evaluate the risk factors for coronary artery lesions in Kawasaki disease and to construct a nomogram for predicting the likelihood of developing such lesions. METHODS Data from 599 patients between January 2012 and June 2020 were reviewed retrospectively. Patients were randomly assigned to the training set (n = 450) and the validation set (n = 149). A comparison of clinical features and laboratory data was performed, followed by multivariate logistic regression analysis to identify independent risk factors and develop the nomogram. The predictive efficiency of the nomogram was evaluated using the calibration curve, area under the receiver operating characteristic curve (AUC), C-index, and decision curve analysis (DCA). RESULTS Intravenous immunoglobulin (IVIG) resistance, delayed IVIG treatment, C-reactive protein, and neutrophil/lymphocyte ratio were identified as independent risk factors for the development of coronary artery lesions. The nomogram was constructed based on these four variables. The calibration curve of the nomogram showed a high degree of agreement between the predicted probability and the actual probability. The AUC of the nomogram in the training and validation set was 0.790 and 0.711, respectively. In addition, DCA revealed that the nomogram provided a significant net benefit, further supporting its clinical utility. CONCLUSIONS The constructed nomogram demonstrates a strong and reliable performance in predicting coronary artery lesions, which enables clinicians to make timely and tailored clinical decisions.
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Affiliation(s)
- Jie Chen
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Jing Li
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yang‐hua Yue
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Yu Liu
- Department of Infectious DiseasesYouxian People's HospitalZhuzhouChina
| | - Tian Xie
- Department of Pediatrics, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Jian‐qiao Peng
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - Zhong‐hua Deng
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
| | - You‐de Cao
- Department of Clinical Laboratory, Hunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
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17
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Gee P, Burgner D, Gee W, Forbes A, Frampton CMA, McCombie A. Rising Kawasaki disease incidence in New Zealand: analysis of national population incidence and outcomes 2000-2017. Arch Dis Child 2023; 108:916-921. [PMID: 37553209 DOI: 10.1136/archdischild-2023-325667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE The recent epidemiology of Kawasaki disease (KD) in New Zealand (NZ) is unknown. Our aim was to describe the incidence, seasonal variation, long-term outcomes and mortality for KD in NZ. DESIGN Retrospective national database analysis. SETTING New Zealand. PATIENTS First hospitalisation and deaths diagnosed with KD. MAIN OUTCOME MEASURES Data were extracted for all hospital admissions in NZ coded as KD (International Classification of Diseases (ICD)-9 and ICD-10) from the National Minimum Dataset 1 January 2000 to 31 December 2017. Age, sex, ethnicity and associated diagnoses were available to review. Intervention rates for immunoglobulin administration were also analysed. RESULTS Over the study period, there were 1008 children with initial hospitalisation for KD. The mean age was 39.8 months (SD 37) and 592 (59%) were boys. The annual incidence rate of KD has increased from 12.2 to 19.5 per 100 000 children <5 years old (0.46 case increase per year; 95% CI 0.09 to 0.83). Children of Asian and Pacific Island ethnicities had the highest incidence (51.2 and 26.1/100 000, respectively). The highest growth in incidence was among East Asian children. The case mortality rate was low (12 of 1008, 1.2%); however, Māori were over-represented (6 of 12 deaths). CONCLUSIONS There is evidence of increasing KD hospitalisation in NZ, similar to recent studies from Northeast Asia and Australia. KD incidence data were available for retrospective review from a national database, but data on complications and outcomes were incomplete. Notification for KD and an active national surveillance system are recommended to improve care. Future work should focus on factors contributing to poorer outcomes in Māori.
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Affiliation(s)
- Paul Gee
- Emergency Medicine, Christchurch Hospital Te Whata Ora, Christchurch, New Zealand
- Department of Surgery and Critical Care, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Waverley Gee
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Angela Forbes
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Andrew McCombie
- Department of Surgery and Critical Care, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
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18
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Wang JR, Zhao HZ, Chang LJ, Xu X, Gao Y, Li M, Kong QY, Wang MM, Zhao CF. Predictive value of monocyte to HDL-C ratio for coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease. Eur J Pediatr 2023; 182:4399-4406. [PMID: 37480545 DOI: 10.1007/s00431-023-05122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
We aimed to investigate the predictive validity of monocyte to high-density lipoprotein cholesterol ratio (MHR) for coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in complete Kawasaki disease (KD). MHR values of a total of 207 complete KD patients were calculated and analyzed with regard to their clinical characteristics and outcomes. We compared the differences in clinical data and laboratory parameters between CAL+ group and CAL- group as well as between IVIG-resistant group and IVIG-responsive group. Spearman's correlation analysis was applied to evaluate the correlation between C-reactive protein (CRP) and MHR. Multivariate logistic regression was used to identify risk factors of CALs and IVIG resistance. Receiver operating characteristic (ROC) curve analysis was chosen to determine the optimal cut-off value of MHR and its validity in predicting CALs and IVIG resistance. The MHR level was significantly higher in the CAL+ group, with cut-off value of 1.30 g/L, yielding a sensitivity of 0.753 and specificity of 0.805, as well as in IVIG-resistant group, with cut-off value of 1.03 g/L, yielding a sensitivity of 0.97 and specificity of 0.485. Multivariate logistic regression showed that MHR was an independent risk factor for CALs but not for IVIG resistance. According to the Spearman's correlation analysis, CRP was positively correlated with the MHR. CONCLUSIONS As a practical, cost-effective inflammatory biomarker, MHR has a significantly predictive value in complete KD children complicated with CALs and IVIG-resistance. Paying more attention to the changes of MHR in KD children may contribute to better understanding of KD development and prognosis in clinical practice. WHAT IS KNOWN • CALs are the most prevalent serious sequela of KD, and approximately 10%~20% of patients do not respond to IVIG therapy. • MHR could be a convenient biomarker to predict the development and progression of CVDs. It has been reported that the MHR is a new prognostic biomarker in several CVDs. WHAT IS NEW • MHR has a significantly predictive value in KD children complicated with CALs and IVIG-resistance. • Compared with the molecular and immunological biomarkers that have been reported, MHR has the characteristics of practical, cost-effective, higher sensitivity and specificity, which can be used as a predictive indicator in complete KD patients.
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Affiliation(s)
- Jia-Ran Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Hai-Zhao Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Lu-Jie Chang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Xue Xu
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Yuan Gao
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Qing-Yu Kong
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Min-Min Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China
| | - Cui-Fen Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 Street, Wenhuaxi Road, Shandong, 250012, Jinan, China.
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Shuai S, Zhang H, Zhang R, Tang M, Luo E, Yang Y, Gao Y, Yue S, Liang H, Cai J. Prediction of coronary artery lesions based on C-reactive protein levels in children with Kawasaki Disease: a retrospective cohort study. J Pediatr (Rio J) 2023; 99:406-412. [PMID: 36977496 PMCID: PMC10373155 DOI: 10.1016/j.jped.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Since coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD), clinically speaking, early prediction of CALs is crucial. The authors aimed to investigate the predictive value of C-reactive protein (CRP) in predicting CALs in KD patients. METHODS KD patients were divided into the CALs group and the non-CALs group. The clinical and laboratory parameters were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of CALs. The receiver operating characteristic curve was applied to determine the optimal cut-off value. RESULTS 851 KD patients who met the inclusion criteria were studied, including 206 in the CALs group and 645 in the non-CALs group. Children in the CALs group had significantly higher CRP levels than the non-CALs group (p < 0.05). Multivariable logistic regression analysis showed that incomplete KD, male, lower hemoglobin, and higher CRP were independent risk factors for predicting CAL (all p < 0.05). The optimal cut-off value of initial serum CRP for predicting CALs was 105.5 mg/L, with a sensitivity of 47.57% and a specificity of 69.61%. In addition, KD patients with high CRP (≥105.5 mg/L) had a higher occurrence of CALs than those with low CRP (<105.5 mg/L) (33% vs 19%, p < 0.001). CONCLUSION The incidence of CALs was significantly higher in patients with high CRP. CRP is an independent risk factor for CALs formation and may be useful for predicting CALs in KD patients.
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Affiliation(s)
- ShuPing Shuai
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - HongXi Zhang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Rui Zhang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Mi Tang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu, China; University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Office of Good Clinical Practice, Chengdu, China
| | - ErDan Luo
- University of Electronic Science and Technology of China, School of Medicine, Chengdu, China; University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Office of Good Clinical Practice, Chengdu, China
| | - YanFeng Yang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pediatric Cardiology, Chengdu, China
| | - Yu Gao
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - ShanLan Yue
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - Hua Liang
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China
| | - JiangHui Cai
- University of Electronic Science and Technology of China, School of Medicine, Chengdu Women's and Children's Central Hospital, Department of Pharmacy, Chengdu, China.
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Liu J, Yuan P, Pang Y, Su D. ITPKC polymorphism (rs7251246 T > C), coronary artery aneurysms, and thrombosis in patients with Kawasaki disease in a Southern Han Chinese population. Front Immunol 2023; 14:1184162. [PMID: 37404818 PMCID: PMC10315485 DOI: 10.3389/fimmu.2023.1184162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives Kawasaki disease (KD) is a commonly acquired pediatric systemic vasculitis disease resulting in coronary artery aneurysm (CAA). The relationship between the ITPKC polymorphism (rs7251246) and the severity and susceptibility to KD in the Han Chinese population in Southern China remains unclear. Methods We enrolled 262 children as controls and 221 children with KD (46 [20.8%] with intravenous immunoglobulin resistance and 82 [37.1%] with CAA). The relationship between the ITPKC rs7251246 polymorphism, KD susceptibility, and CAA formation was investigated. Results While the ITPKC rs7251246 T>C polymorphism was not significantly associated with KD susceptibility, it was significantly related to the CAA risk in children with KD [CC/CT vs. TT: adjusted odds ratio [OR] 2.089, 95% confidence interval [CI] 1.085-4.020]. Male children with the rs7251246 CT/TT genotype had a significantly lower risk of thrombosis [CT/TT vs. CC: adjusted OR 0.251, 95% CI 0.068-0.923]. Children with KD, especially those with CAA, had significantly downregulated ITPKC mRNA compared to healthy children. ITPKC mRNA levels were lower in children with CAA who developed thrombosis (P=0.039). In children with KD, the CC genotype showed lower mRNA levels of ITPKC (P=0.035). Conclusion The ITPKC rs7251246 T>C polymorphism may be a risk factor for CAA and thrombosis in children with KD in the Han Chinese population, likely due to differences in mature mRNA levels caused by interference of RNA splicing. Dual antiplatelet therapy for thrombosis is recommended for male children with the rs7251246 CC genotype.
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Affiliation(s)
| | | | | | - Danyan Su
- *Correspondence: Yusheng Pang, ; Danyan Su,
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21
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Jiao W, Wei L, Jiao F, Pjetraj D, Feng J, Wang J, Catassi C, Gatti S. Very early onset of coronary artery aneurysm in a 3-month infant with Kawasaki disease: a case report and literature review. Ital J Pediatr 2023; 49:60. [PMID: 37270515 DOI: 10.1186/s13052-023-01478-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a medium vessel vasculitis, of unknown etiology, typically presenting in children younger than 5 years of age. Prolonged fever (at least five days) is a major clinical criterion of KD, while cardiac involvement may occur in up to 25% of patients, generally in the second week of the disease. CASE PRESENTATION We describe the case of KD developing in a 3-month infant, with an early occurrence of coronary artery aneurysm after only 3 days of fever, complicated by thrombosis, requiring aggressive treatments. CONCLUSIONS Time of development of cardiac complications can be different in young infants with KD and both diagnostic criteria and treatment indications should be individualized in this class of age.
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Affiliation(s)
- Wenyan Jiao
- Department of Psychology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Wei
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Fuyong Jiao
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Dorina Pjetraj
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy
| | - Jianying Feng
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Jvyan Wang
- Shaanxi Kawasaki Disease Diagnosis and Treatment Center, Xi'an, China
| | - Carlo Catassi
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy
| | - Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, Via Filippo Corridoni 11, 60123, Ancona, Italy.
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22
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Liu J, Su D, Yuan P, Ye B, Qin S, Pang Y. Risk Factors for Coronary Artery Aneurysm in a Chinese Pediatric Population with Kawasaki Disease at Low Risk of Intravenous Immunoglobulin Resistance: A Retrospective Cohort Study. Cardiology 2023; 148:457-468. [PMID: 37231847 PMCID: PMC10614276 DOI: 10.1159/000530708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Multiple scoring systems for predicting intravenous immunoglobulin (IVIG) resistance have been developed. Although low-scoring patients with Kawasaki disease (KD) have a favorable prognosis, many develop coronary artery aneurysms (CAAs). Herein, we determined the risk factors for CAA development among patients with KD with low risk of IVIG resistance. METHODS We compared 14 scoring systems for predicting IVIG resistance among patients with KD hospitalized from 2003 to 2022. Patients were risk stratified using an optimal scoring system. Association between baseline characteristics and CAA development was assessed within the low-risk group. RESULTS Overall, 664 pediatric patients with KD were included; 108 (16.3%) had IVIG resistance, and the Liping scoring system had the highest area under the curve (0.714). According to this system, 444 (66.9%) patients with KD were classified as having low risk of developing IVIG resistance (<5 points). CAA development was significantly associated with male sex (odds ratio [OR], 1.946; 95% CI: 1.015-3.730), age <6 months at fever onset (OR, 3.142; 95% CI: 1.028-9.608), and a baseline maximum Z score of ≥2.72 (OR, 3.451; 95% CI: 2.582-4.612). CAA incidence increased with the number of risk factors, and comparisons with a Kobayashi score of <5 points among patients with KD revealed similar results. CONCLUSIONS Predicting the response to IVIG might help further reduce CAA development in patients with KD.
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Affiliation(s)
- Jie Liu
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China,
| | - Danyan Su
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Piaoliu Yuan
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Yang Y, Huang J, Yan H, Li X, Liu P, Zhou W, Zhang X, Lu X, Xiao Z. Clinical characteristics and outcomes of children with Kawasaki disease combined with sepsis in the pediatric intensive care unit. Front Cell Infect Microbiol 2023; 13:1101428. [PMID: 37234775 PMCID: PMC10206258 DOI: 10.3389/fcimb.2023.1101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Background Kawasaki disease (KD) is a vascular inflammatory disease with unknown pathogenesis. There are few studies on KD combined with sepsis worldwide. Purpose To provide valuable data regarding clinical characteristics and outcomes related to pediatric patients with KD combined with sepsis in pediatric intensive care unit (PICU). Methods We retrospectively analyzed the clinical data of 44 pediatric patients admitted in PICU at Hunan Children's Hospital with KD combined with sepsis between January 2018 and July 2021. Results Of the 44 pediatric patients (mean age, 28.18 ± 24.28 months), 29 were males and 15 were female. We further divided the 44 patients into two groups: KD combined with severe sepsis (n=19) and KD combined with non-severe sepsis (n=25). There were no significant between-group differences in leukocyte, C-reactive protein, and erythrocyte sedimentation rate. Interleukin-6, interleukin-2, interleukin-4 and procalcitonin in KD with severe sepsis group were significantly higher than those in KD with non-severe sepsis group. And the percentage of suppressor T lymphocyte and natural killer cell in severe sepsis group were significantly higher than those in non-severe group, while the CD4+/CD8+ T lymphocyte ratio was significantly lower in KD with severe sepsis group than in KD with non-severe sepsis group. All 44 children survived and were successfully treated after intravenous immune globulin (IVIG) combined with antibiotics. Conclusion Children who develop with KD combined with sepsis have different degrees of inflammatory response and cellular immunosuppression, and the degree of inflammatory response and cellular immunosuppression is significantly correlated with the severity of the disease.
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Affiliation(s)
- Yufan Yang
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Jiaotian Huang
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Haipeng Yan
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Xun Li
- Pediatrics Research Institute of Hunan Province, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Pingping Liu
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Wu Zhou
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Xinping Zhang
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Xiulan Lu
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Zhenghui Xiao
- Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, Hunan, China
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24
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Liu J, Su D, Yuan P, Huang Y, Ye B, Liang K, Pang Y. Prognostic nutritional index value in the prognosis of Kawasaki disease with coronary artery lesions. Front Nutr 2023; 10:1075619. [PMID: 36819679 PMCID: PMC9929364 DOI: 10.3389/fnut.2023.1075619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives The prognostic nutritional index (PNI) is a purported predictor of intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD). However, limited data exist on CAA regression. This study aimed to confirm whether the PNI is a predictor for CAA persistency in patients with KD. Methods This retrospective study grouped 341 patients with KD based on the coronary artery status and time of aneurysm persistence. The clinical and laboratory parameters were compared, and multivariate logistic regression analysis was performed to identify the independent risk factors for persistent CAA. The receiver operating characteristic (ROC) curve was further used to assess the predictive values of the PNI in persistent CAA. Results Among the study patients, 80 (23.5%) presented with CAA, including CAA persisting for 2 years in 17 patients (5.0%). Patients with CAA were more frequently treated with corticosteroids (p < 0.016). No statistically significant differences were found in the nutritional status and PNI among patients with or without coronary artery lesions, regardless of injury severity. Patients in the persistent CAA group presented with higher rates of overnutrition and showed lower PNI values and a higher incidence of thrombosis than those in the normal group (p < 0.05). The PNI and the maximum Z-score at 1 month of onset were significantly associated with CAA persisting for 2 years and may be used as predictors of persistent CAA. The area under the ROC curve was 0.708 (95% confidence interval, 0.569-0.847), and a 40.2 PNI cutoff yielded a sensitivity and specificity of 41 and 92%, respectively, for predicting CAA persisting for 2 years. Kaplan-Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in patients with PNI values of ≤40 than in those with PNI values of >40 (hazard ratio, 2.958; 95% confidence interval, 1.601-5.464; p = 0.007). After sampling-time stratification, the PNI differed significantly between patients with and without persistent CAA when sampled on the second (p = 0.040), third (p = 0.028), and fourth days (p = 0.041) following disease onset. Conclusion A lower PNI value is an independent risk factor for CAA persisting for 2 years in patients with KD, besides the maximum Z-score at 1 month after onset. Furthermore, the PNI obtained within 4 days from fever onset may possess greater predictive power for patients with persistent CAA.
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Koliou MG, Aristidou A, Mazeri S, Georgiou E, Agathocleous M, Kousparou M, Elia A, Jossif A. Epidemiology and risk factors for resistance to treatment of Kawasaki disease in Cyprus. Sci Rep 2023; 13:352. [PMID: 36611091 PMCID: PMC9825398 DOI: 10.1038/s41598-023-27694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of early childhood. There are no previous studies on KD in Cyprus. The aim of this study was to evaluate the epidemiology of KD in Cyprus, risk factors for resistance to treatment and the development of cardiac complications. This is a retrospective multicenter study of pediatric patients with KD hospitalized between January 2000 and-December 2019. The data were collected from medical records. A total of 136 patients with KD were included in the study. 83% of patients were < 5 years of age and 10% were < 6 months. Thirty patients (22%) developed coronary artery lesions. Serum sodium ≤ 133 mmol/L, albumin ≤ 3.2 g/dl, ALT ≥ 80 U/L and neutrophils percentage ≥ 80% at diagnosis, were identified as risk factors for resistance to IVIG. Clinical and epidemiological characteristics of KD in Cyprus population were similar to those reported in the literature. Although the majority of cases received appropriate treatment in time, cardiac complications still occurred.
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Affiliation(s)
- Maria G. Koliou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus ,grid.6603.30000000121167908Medical School, University of Cyprus, Nicosia, Cyprus ,5 Agiou Symeou Street, 2037 Strovolos, Nicosia, Cyprus
| | - Athina Aristidou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Stella Mazeri
- grid.4305.20000 0004 1936 7988Epidemiology and Public Health, Roslin Institute, Royal Dick School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, UK
| | - Elena Georgiou
- grid.452654.40000 0004 0474 1236Paediatric Department, Limassol General Hospital, Limassol, Cyprus
| | - Maria Agathocleous
- grid.452654.40000 0004 0474 1236Paediatric Department, Limassol General Hospital, Limassol, Cyprus
| | - Marianna Kousparou
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Avraam Elia
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, Acropolis 1474, Nicosia, Cyprus
| | - Antonis Jossif
- Paedi Center for Specialized Paediatrics, Athalassis 178, Strovolos 2024, Nicosia, Cyprus
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Lai Y, Feng M, Deng J, Tan B, Ban J, Zheng J. Medication analysis and pharmaceutical care for a child with Kawasaki disease: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e32488. [PMID: 36607867 PMCID: PMC9829272 DOI: 10.1097/md.0000000000032488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To explore the ideas and methods of clinical pharmacists regarding drug therapy for children with Kawasaki disease. METHODS By participating in a whole drug treatment process for a child with Kawasaki disease, the rationality of the drug treatment plan was analyzed, pharmaceutical care was provided for the child, and a pharmaceutical care model suited to this child was developed. RESULTS After treatment, the child was discharged from the hospital, and all signs and major inflammatory indicators returned to normal. The child's parents were instructed to bring medication, visit regularly, and adjust medication. CONCLUSION Through the entire process of pharmaceutical care, clinical pharmacists are able to identify and resolve drug treatment-related issues in a timely manner, and also make suggestions on rational drug use, which can improve the safety and compliance of drug use in children and the quality of clinical drug treatment.
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Affiliation(s)
- Yingqiang Lai
- Department of Pharmacy, Yuebei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China
- * Correspondence: Yingqiang Lai, MD, Department of Pharmacy, Yuebei People’s Hospital, Shaoguan, Guangzhou 512023, People’s Republic of China (e-mail: )
| | - Meirou Feng
- Department of Pharmacy, Yuebei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China
| | - Jianrong Deng
- Department of Pediatric, Yuebei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China
| | - Benren Tan
- Department of Pharmacy, Yuebei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China
- Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
| | - Junfeng Ban
- Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
- The Innovation Team for Integrating Pharmacy with Entrepreneurship, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
| | - Jinkun Zheng
- Department of Pharmacy, Yuebei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China
- Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
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Bressieux-Degueldre S, Gradoux E, Di Bernardo S, Sekarski N. Complete and incomplete Kawasaki disease: Clinical differences and coronary artery outcome from a national prospective surveillance study in Switzerland. Front Pediatr 2023; 11:1137841. [PMID: 37020652 PMCID: PMC10067721 DOI: 10.3389/fped.2023.1137841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction The aim of this national prospective surveillance study was to compare the clinical presentation, laboratory findings, treatment, and coronary artery outcome in patients with incomplete and complete Kawasaki disease (KD). Methods Between March 2013 and February 2019, children with a diagnosis of complete and incomplete KD were reported by the Swiss Paediatric Surveillance Unit and prospectively enrolled. Clinical data, laboratory values, treatment, and echocardiographic features were collected at diagnosis and 1 year of follow-up. Data were compared between children with complete or incomplete KD. Results A total of 351 questionnaires were registered from children with a diagnosis of KD. Of them, 219 (62.4%) children had complete KD, and 132 (37.6%) children had incomplete KD. Children with incomplete KD were younger and had a longer-lasting fever; however, there were no differences in the level of C-reactive protein. All but four children received intravenous immunoglobulin treatment, whereas 14% of children were treated with corticosteroids. Children with incomplete KD were more often treated with corticosteroids than children with incomplete KD (p = 0.01). At diagnosis, 39 (11.1%) patients had only coronary artery dilation and 57 (16.2%) had at least one coronary artery aneurysm. There were no differences in coronary artery involvement between the two groups. At follow-up, 273 of 294 (92.8%) patients had no coronary artery involvement, with no difference between the two groups (p = 0.609). The overall incidence of coronary artery aneurysms at diagnosis was 16.2%. At follow-up, most coronary artery aneurysms had regressed, and coronary artery aneurysms were present in only 5.8% of the patients. Coronary artery aneurysms were slightly more frequent in patients with incomplete KD at follow-up (p = 0.039) but not at diagnosis (p = 0.208). Conclusion Although the clinical presentation in children with incomplete and complete KD differs, the absence of coronary artery involvement does not. The use of corticosteroids appears to be preventive against the development of coronary artery aneurysms in these patients. However, the results of this study suggest a lower rate of coronary artery aneurysm regression in patients with incomplete KD. Further studies on a larger scale are needed to assess the risk of non-regression of coronary artery aneurysms in this particular group of patients.
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Affiliation(s)
- S Bressieux-Degueldre
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - E Gradoux
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - S Di Bernardo
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - N Sekarski
- Pediatric Cardiology Unit, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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28
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Philbin D, Hall D. Fifteen-minute consultation: The approach to the febrile child. Arch Dis Child Educ Pract Ed 2022; 107:422-426. [PMID: 34433581 DOI: 10.1136/archdischild-2020-321335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022]
Abstract
Febrile children presenting to the emergency department pose unique challenges. This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red flags and appropriate investigations. Emergency clinicians must be aware of the risk factors for SBI in febrile children, including young age, ill-appearing children and those with complex comorbidities or immunodeficiency. The presence of red flags in febrile children should immediately alert concern and prompt senior clinician review. This article also discusses the appropriate use of investigations and their role in complementing clinical assessment. When discharging children home after emergency department assessment, safety netting should be undertaken to ensure parents are aware when to seek further medical opinion. The presence of a prolonged fever of 5 days or longer should alert suspicion and usually requires further investigation.
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Affiliation(s)
- Deirdre Philbin
- Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Dani Hall
- Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland
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29
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Liu J, Huang Y, Qin S, Su D, Ye B, Pang Y. Extracardiovascular injury complications in Kawasaki disease. Pediatr Investig 2022; 6:241-249. [PMID: 36582273 PMCID: PMC9789935 DOI: 10.1002/ped4.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
Importance Patients with Kawasaki disease (KD) experience various extracardiovascular injury complications, which may affect their outcomes. Objective To investigate the incidence and clinical characteristics of extracardiovascular complications in children with KD. Methods The clinical data of patients diagnosed with KD in the First Affiliated Hospital of Guangxi Medical University from January 2003 to January 2021 were reviewed. The clinical characteristics and extracardiovascular complications were compared among patients stratified by age, intravenous immunoglobulin (IVIG) therapy responsiveness, and coronary status. Results A total of 511 patients with KD were included, 357 (69.9%) were aged 1-5 years. Children aged <1 year (21.5%) and boys (70.8%) were more likely to have coronary artery lesions (CALs). The incidence of incomplete KD was lowest in 1-5-year-old patients (19.6%). Involvement of the hematological system gradually decreased with age (<1 year, 51.8%; 1-5 years, 36.7%; >5 years, 29.5%), whereas the involvement of the joints gradually increased with age (<1 year, 2.7%; 1-5 years, 6.2%; >5 years, 20.5%). Nervous system involvement was more common in IVIG non-responders (15.7% [13/83] vs. 5.4% [23/428], P = 0.001). However, there were no significant differences in extracardiovascular injury complications between patients with or without CALs. Interpretation KD can involve multiple organ injuries as well as cardiovascular complications, and nervous systerm involvement may be more common in patients unresponsive to IVIG.
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Affiliation(s)
- Jie Liu
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Yuqin Huang
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Suyuan Qin
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Danyan Su
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Bingbing Ye
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
| | - Yusheng Pang
- Department of PediatricsFirst Affiliated HospitalGuangxi Medical UniversityNanningChina
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Liu J, Yue Q, Qin S, Su D, Ye B, Pang Y. Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease. Front Cardiovasc Med 2022; 9:969495. [PMID: 36158849 PMCID: PMC9505689 DOI: 10.3389/fcvm.2022.969495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551–0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population.
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[Pediatric expert consensus on the application of aspirin in Kawasaki disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:597-603. [PMID: 35652428 PMCID: PMC9250407 DOI: 10.7499/j.issn.1008-8830.2203190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 01/24/2023]
Abstract
Kawasaki disease (KD) is one of the common acquired heart diseases in children aged <5 years and is an acute systemic vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for the prevention of coronary artery lesion in acute KD; however, there are still controversies over the role and optimal dose of aspirin. The consensus was formulated based on the latest research findings of KD treatment in China and overseas and comprehensive discussion of pediatric experts in China and put forward recommendations on the dose, usage, and course of aspirin treatment in the first-line treatment of KD.
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Lee W, Cheah CS, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (B Aires) 2022; 58:medicina58060734. [PMID: 35743997 PMCID: PMC9227912 DOI: 10.3390/medicina58060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Kawasaki disease (KD) has shown a marked increase in trend over the globe, especially within the last two decades. Kawasaki disease is often seen in the paediatric population below five years old, while it is rare for those who are beyond that age. Up to this date, no exact causes has been identified although KD was found more than half a century ago. The underlying pathogenesis of the disease is still unelucidated, and researchers are trying to unlock the mystery of KD. To further complicate the diagnosis and the prompt management, a specific biomarker for the diagnosis of KD is yet to be discovered, making it hard to differentiate between KD and other diseases with a similar presentation. Nonetheless, since its discovery, clinicians and scientists alike had known more about the different clinical aspects of typical KD. Thus, this article intends to revisit and review the various clinical manifestations and laboratory characteristics of KD in order to guide the diagnosis of KD.
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Affiliation(s)
- Wendy Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Mohammad Shukri Khoo
- Department of Pediatric, Hospital Wanita dan Kanak Kanak Sabah, Kota Kinabalu 88996, Malaysia;
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
- Correspondence: ; Tel.: +603-91748510
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Zheng Y, Huang S, Zhang J, Hou J, Wu F, Wang W, Han X, Gui Y. Melatonin alleviates vascular endothelial cell damage by regulating an autophagy-apoptosis axis in Kawasaki disease. Cell Prolif 2022; 55:e13251. [PMID: 35582751 PMCID: PMC9201377 DOI: 10.1111/cpr.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/09/2022] [Accepted: 04/24/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives Melatonin has been reported to be an appropriate candidate for mitigating various cardiovascular injuries, owing to its versatility. This study aimed to explore the role of melatonin in Kawasaki disease (KD)‐associated vasculitis and its underlying mechanisms. Material and Methods The role of melatonin was evaluated in human coronary artery endothelial cells (HCAECs), peripheral blood mononuclear cells from KD patients, human THP1 cell line in vitro, and a Candida albicans water‐soluble fraction (CAWS)‐induced KD mouse model in vivo. Cell proliferation assay, cell apoptosis assay, cell co‐culture, RNA extraction, RNA sequencing, reverse transcription quantitative PCR, enzyme‐linked immunosorbent assay (ELISA), transwell assay, western blot, dual‐luciferase reporter assay, and autophagic flux assay were performed to investigate the function and regulatory mechanisms of melatonin in vitro, while haematoxylin and eosin staining, Verhoeff's van Gieson staining, ELISA, and immunohistochemical analysis were performed to detect the effect of melatonin in vivo. Results Melatonin suppressed cell apoptosis directly reduced the expression of endothelial cell damage markers in HCAECs, and alleviated vasculitis in the CAWS‐induced KD mouse model. Mechanistically, melatonin promoted autophagy by activating the melatonin/ melatonin receptor (MT)/cAMP‐response element binding protein (CREB) pathway and upregulating the expression of autophagy‐related gene‐3, thereby suppressing cell apoptosis in an autophagy‐dependent manner. Additionally, melatonin decreased the production of pro‐inflammatory cytokines in macrophages and indirectly reduced the immunopathological damage of HCAECs. Conclusions This study revealed that melatonin protects vascular endothelial cells in KD, by suppressing cell apoptosis in an autophagy‐dependent manner and reducing the immunopathological damage mediated by macrophages.
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Affiliation(s)
- Yuanzheng Zheng
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Saihua Huang
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.,Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, Fudan University, Shanghai, China
| | - Jialing Zhang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Jia Hou
- Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Wu
- Department of Neonatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenji Wang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
| | - Xiao Han
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.,Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, Fudan University, Shanghai, China
| | - Yonghao Gui
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China
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Chen X, Gao L, Zhen Z, Wang Y, Na J, Yu W, Chu X, Yuan Y, Qian S. Risk Factors and Predictive Models for Intravenous Immunoglobulin Resistance in Children with Recurrent Kawasaki Disease. J Inflamm Res 2022; 15:2877-2889. [PMID: 35571506 PMCID: PMC9091694 DOI: 10.2147/jir.s360802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the risk factors and develop predictive models for intravenous immunoglobulin (IVIG) resistance in children with recurrent Kawasaki disease (KD). Patients and Methods Patients with recurrent KD were retrospectively reviewed. Clinical and laboratory data at recurrence were collected and compared between patients with and without IVIG resistance. The patients were randomly divided into training and validation cohorts for model development and validation. All variables were subjected to standard Lasso and its variant group Lasso analyses, respectively, to construct predictive models. Model performance was evaluated by receiver operating characteristics (ROC) curves, calibration curves, and Hosmer-Lemeshow tests. Results A total of 90 children with recurrent KD were included. A total of 16 cases were IVIG resistant. The patients with IVIG resistance had higher age and IVIG resistance probability at the first episode, increased CRP levels, neutrophil count, neutrophil percentage, direct bilirubin level, prothrombin time, and international normalized ratio, and decreased lymphocyte count, lymphocyte percentage, and serum sodium levels. Five variables including age and IVIG resistance at the first episode, lymphocytes count, serum sodium levels, and CRP levels were finally selected by standard Lasso (lLasso model) and four variables including age and IVIG resistance at the first episode, neutrophil percentage, and CRP levels were selected by group Lasso (gLasso). ROC curves suggested lLasso and gLasso models had similar excellent discrimination in both the training cohort (0.895 vs 0.906) and the validation cohort (0.855 vs 0.909). Hosmer-Lemeshow tests suggested the two models exerted a good calibration. Two nomograms were also constructed to facilitate the potential application of the two models. Conclusion Age and IVIG resistance at the first episode and some laboratory variables may be risk factors for IVIG resistance in recurrent KD. Two predictive models for IVIG resistance with excellent performance were established in recurrent KD. External validation should be performed before clinical use.
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Affiliation(s)
- Xi Chen
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Lu Gao
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Zhen Zhen
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Ying Wang
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Jia Na
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Wen Yu
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Xinyuan Chu
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Yue Yuan
- Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China,Correspondence: Yue Yuan, Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56, Nanlishilu, District Xicheng, Beijing, 100045, People’s Republic of China, Email ;
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China,Suyun Qian, Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56, Nanlishilu, District Xicheng, Beijing, 100045, People’s Republic of China, Email ;
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Lao S, Zhou T, Kuo HC, Zhong G, Zeng W. Risk Factors for Coronary Artery Lesionsin Kawasaki Disease Independent of Antibiotic Use in Chinese Children. Front Public Health 2022; 10:817613. [PMID: 35602151 PMCID: PMC9118346 DOI: 10.3389/fpubh.2022.817613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the impact of antibiotics used in Kawasaki disease (KD) with coronary artery lesions (CAL) and identify independent risk factors. Methodology This study reviewed the records of 287 KD patients between the years 2016 and 2020. Patients were grouped by their outcome, the CAL group, and a no-coronary artery lesions (NCAL) group, and stratified by the use of antibiotics. We collected clinical and laboratory data before the intravenous immunoglobulin (IVIG) treatment. Results The two groups of KD patients with and without CAL were compared. The results showed that there are significant differences between groups which were erythrocyte count (p = 0.045) and hemoglobin (p = 0.005), red blood cell-specific volume (p = 0.001), immature granular cells percentage (p = 0.006), total protein (p = 0.045), albumin (p = 0.041), alkaline phosphatase (p = 0.023), and chlorine (p = 0.006). After multivariate logistic regression, neutrophil granulocyte percentage (odds ratio [OR] = 1.200, 95% confidence interval [CI]: 1.008-1.428, p = 0.040), lymphocyte percentage (p = 0.028, OR = 1.243, 95% CI: 1.024-1.508, p = 0.028) and total protein (OR = 4.414, 95% CI: 1.092-17.846, p = 0.037) were found to be independent risk factors for CAL. After analyzing the cases with a history of antibiotic use, multivariate analysis showed no indicators were considered independent risk factors for CAL. Conclusion Neutrophil granulocyte percentage, Lymphocyte percentage and total protein were independent risks for CAL in KD without antibiotics use history. The use of antibiotics affected physiological indicators of KD patients.
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Affiliation(s)
- Sixian Lao
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou, China
| | - Tao Zhou
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Guoping Zhong
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou, China
| | - Weiwei Zeng
- The Second People's Hospital of Longgang District, Shenzhen, China
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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Kwon D, Choe YJ, Kim SY, Chun BC, Choe SA. Ambient Air Pollution and Kawasaki Disease in Korean Children: A Study of the National Health Insurance Claim Data. J Am Heart Assoc 2022; 11:e024092. [PMID: 35475377 PMCID: PMC9238605 DOI: 10.1161/jaha.121.024092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Kawasaki disease (KD) is a systemic vasculitis of unknown etiology that primarily affects children under 5 years of age. Some researchers suggested a potential triggering effect of air pollution on KD, but the findings are inconsistent and limited by small sample size. We investigated the association between ambient air pollution and KD among the population of South Korea younger than 5 years using the National Health Insurance claim data between 2007 and 2019. Methods and Results We obtained the data regarding particulate matter ≤10 or 2.5 µm in diameter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone from 235 regulatory monitoring stations. Using a time‐stratified case‐crossover design, we performed conditional logistic regression to estimate odds ratios (OR) of KD according to interquartile range increases in each air pollutant concentration on the day of fever onset after adjusting for temperature and relative humidity. We identified 51 486 children treated for KD during the study period. An interquartile range increase (14.67 μg/m3) of particulate matter ≤2.5 µm was positively associated with KD at lag 1 (OR, 1.016; 95% CI, 1.004–1.029). An interquartile range increase (2.79 ppb) of sulfur dioxide concentration was associated with KD at all lag days (OR, 1.018; 95% CI, 1.002–1.034 at lag 0; OR, 1.022; 95% CI, 1.005–1.038 at lag 1; OR, 1.017; 95% CI, 1.001–1.033 at lag 2). Results were qualitatively similar in the second scenario of different fever onset, 2‐pollutant model and sensitivity analyses. Conclusions In a KD‐focused national cohort of children, exposure to particulate matter ≤2.5 µm and sulfur dioxide was positively associated with the risk of KD. This finding supports the triggering role of ambient air pollution in the development of KD.
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Affiliation(s)
- Dayoon Kwon
- Department of Epidemiology UCLA Fielding School of Public Health Los Angeles CA
| | - Young June Choe
- Department of Pediatrics Korea University Anam Hospital Seoul Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health Graduate School of Cancer Science and Policy National Cancer Center Goyang-si Gyeonggi-do Korea
| | - Byung Chul Chun
- Department of Epidemiology & Health Informatics Graduate School of Public Health Korea University Seoul Korea.,Department of Preventive Medicine Korea University College of Medicine Seoul Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine Korea University College of Medicine Seoul Korea.,Division of Life Sciences Korea University Seoul Korea
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Yu H, Sun W, Wu H, Zhang S, Xu Z, Wu R, Rong X, Qiu H, Zhu J, Zhang C, Chu M. The Significance of Symptoms in Predicting Coronary Artery Aneurysms of Kawasaki Disease, Especially in Female Patients. Front Cardiovasc Med 2022; 9:823862. [PMID: 35571186 PMCID: PMC9095924 DOI: 10.3389/fcvm.2022.823862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown etiology that occurs during early childhood, commonly involving the coronary artery, and can lead to coronary artery aneurysms (CAAs). Methods The demographic, clinical, and laboratory data of KD patients without coronary artery lesions (N-CAL) and with CAA were collected during 2005–2020 at the Second Affiliated Hospital of Wenzhou Medical University. The patients were divided into the development cohort and the validation cohort. First, we compared the general information, symptoms, and laboratory data of N-CAL and CAA patients in the development cohort and the total cohort and screened out the different indices by logistic regression analysis. Then, we established three models and compared the area under the curve (AUC) values of the receiver operating characteristic (ROC) curves to identify meaningful models for CAA, which were further verified by decision curve analysis (DCA). Second, taking into account previous reports on the importance of gender to CAA, gender stratification was conducted. Results The analysis of clinical and blood indices revealed the following novel features: (i) Many factors were found to be related to CAA, including IVIG resistance and the symptoms of rash, oral changes, and cervical lymphadenopathy. (ii) The development cohort was analyzed by logistic regression, and three models were established. The ROC curves showed that Model 2, composed of IVIG resistance, rash, oral changes, and cervical lymphadenopathy, had a better AUC value and easily to evaluate in the prediction of CAA. (iii) The selected model for predicting CAA in the development cohort was further confirmed in the validation cohort through DCAs. (iv)We further compared the items enrolled in the three models above between the N-CAL and CAA groups by sex, and the results indicated that female KD patients without rash, oral changes, and cervical lymphadenopathy were more likely to develop CAA. Conclusion The absence of rash, oral changes, and cervical lymphadenopathy are risk factors for CAA, especially in female KD patients. Accurately recognizing symptoms, early diagnosis, and standard treatment for KD are key to reducing the incidence of CAA.
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Luo HH, Fan GZ, Wu YF, Hu P. Grisel syndrome and peripheral arthritis simultaneously occurred in a 7-year-old Chinese boy with Kawasaki disease. Arch Med Sci 2022; 18:816-819. [PMID: 35591823 PMCID: PMC9103385 DOI: 10.5114/aoms/148123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Huang Huang Luo
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo Zhen Fan
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Fang Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Qiu Z, Liu HH, Fan GZ, Chen WX, Hu P. The clinical implications of serum ferritin in Kawasaki disease: a helpful biomarker for evaluating therapeutic responsiveness, coronary artery involvement and the tendency of macrophage activation syndrome. Arch Med Sci 2022; 18:267-274. [PMID: 35154547 PMCID: PMC8826798 DOI: 10.5114/aoms/144293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Serum ferritin (SF) is an acute-phase reactant in inflammatory diseases. Our aim was to analyze the clinical implications of SF in Kawasaki disease (KD). METHODS 244 KD children were divided into 6 subgroups. SF, inflammatory mediators and blood cell counts were detected. RESULTS (1) SF dramatically increased in the acute phase of KD and maintained after IVIG therapy; (2) SF increased in IVIG-nonresponsive KD patients (AUC = 0.705; sensitivity: 57.10%; specificity: 82.90%); SF positively correlated with the internal diameter of the coronary artery (AUC = 0.603; sensitivity: 92.30%; specificity: 37.70%); (3) SF increased in 4 patients with the macrophage activation syndrome (MAS)/MAS tendency (979.03 ±474.19 μg/l). CONCLUSIONS SF is implied to be a helpful biomarker for forecasting IVIG-nonresponsive KD, coronary artery abnormalities (CAAs) and MAS tendency.
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Affiliation(s)
- Zhen Qiu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Hui Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo Zhen Fan
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Xia Chen
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Cheah CS, Lee WWL, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Kawasaki disease in Malaysia: Biochemical profile, characterization, diagnosis and treatment. Front Pediatr 2022; 10:1090928. [PMID: 36714643 PMCID: PMC9880227 DOI: 10.3389/fped.2022.1090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the East Asian countries. Nevertheless, to date, the data on KD in Malaysia are limited. This study aimed to evaluate the epidemiology, clinical features, treatment, and outcomes of KD among the pediatric patients admitted to Hospital Canselor Tunku Muhriz (HCTM), Kuala Lumpur, Malaysia. METHOD A retrospective cohort study of 66,500 pediatric patients presented at HCTM from the year 2004 to 2021 was conducted. RESULTS 62 KD cases out of 66,500 pediatric admissions were reported, with a male-to-female ratio of 1.58 to 1. Majority of KD patients (95.0%) were younger than 5 years old. Prior infection was reported in 5 KD patients (8.1%). Apart from the classical features, manifestations of various organ systems including cardiovascular (16.1%), gastrointestinal (43.5%), neurological (1.61%), musculoskeletal (1.61%), and genitourinary (17.7%) systems were observed. There was a significant association between sterile pyuria and coronary artery aneurysm (CAA) (p < 0.05). Interestingly, abnormal liver parameters (p < 0.05) and incomplete KD (p < 0.05) were significantly related to IVIG resistance. DISCUSSION The presence of family history, immunological disorder, and previous infection in our KD patients suggested that there is a possibility of genetic, immunological, and infectious roles in the pathophysiology of KD. IVIG resistance is more likely to occur in KD patients with hepatic dysfunction or incomplete KD presentation. These findings highlighted the significant contribution of laboratory parameters to the prognosis of KD, prompting more in-depth research on the KD scoring systems and their relevance in this country.
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Affiliation(s)
- Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wendy Wei Li Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohammad Shukri Khoo
- Department of Pediatric, Universiti Kebangsaan Malaysia Specialist Children's Hospital (HPKK), Kuala Lumpur, Malaysia
| | | | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Pediatric, Universiti Kebangsaan Malaysia Specialist Children's Hospital (HPKK), Kuala Lumpur, Malaysia
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Tsuchihashi T, Kakimoto N, Kitano N, Suenaga T, Ikeda K, Izui M, Kobayashi N, Yoshimura K, Nakamura Y, Suzuki H. Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan. Pediatr Int 2022; 64:e15391. [PMID: 36256501 DOI: 10.1111/ped.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z-score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD. METHODS The 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z-score, treatment by KD treatment stage, and predictors of CAAs. RESULTS The response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z-scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second-line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third-line treatment. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs. CONCLUSIONS Using the Z-score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year are useful predictors of CAAs.
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Affiliation(s)
- Tomoya Tsuchihashi
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Kakimoto
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Naomi Kitano
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Health Administration Center, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Suenaga
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kazuyuki Ikeda
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Izui
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Division of Pediatrics, Kobetokushukai Hospital, Hyogo, Japan
| | - Naho Kobayashi
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Division of Pediatrics, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Ken Yoshimura
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Yoshikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Suzuki
- Society of Kinki Area Kawasaki Disease Research, Suita city, Osaka, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan.,Department of Pediatrics, Wakayama Tsukushi Medical and Welfare Center, Iwade, Japan
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Xia Y, Qiu H, Wen Z, Shi H, Yu H, Li J, Zhang Q, Wang J, Rong X, Wu R, Chu M. Albumin level and progression of coronary artery lesions in Kawasaki disease: A retrospective cohort study. Front Pediatr 2022; 10:947059. [PMID: 36186633 PMCID: PMC9516112 DOI: 10.3389/fped.2022.947059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Albumin (ALB) level is closely associated with the occurrence of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD). The association between ALB level and CALs progression, is critical to the prognosis of KD patients. But little is known about it. This study aims to investigate the effect of the ALB level on CALs progression in KD patients. METHODS A total of 3,479 KD patients from 1 January 2005 to 30 November 2020, in Wenzhou, China were recruited. A total of 319 KD patients who had CALs and ALB data, and finish the follow-up as requested were enrolled in this study. They were classified into the low ALB group and the normal ALB group, divided by 30 g/L. CALs outcomes were classified into two categories according to the CALs changes from the time that CALs were detected within 48 h before or after IVIG treatment to 1 month after disease onset: progressed and no progressed. Multiple logistic regression models were used to assess the independent effect of ALB level on CALs progression among KD patients. Stratified analysis was performed to verify the ALB level on CALs progression among patients in different subgroups. RESULTS Higher proportion of IVIG resistance (P < 0.001), receiving non-standard therapy (P < 0.001), and receiving delayed IVIG treatment (P = 0.020) were detected in patients with lower ALB level. Patients with lower ALB level had higher C-reactive protein (CRP) level (P = 0.097) and white blood cell count (WBC) (P = 0.036). After adjustment for confounders, patients with lower ALB level had higher odds of CALs progression; the adjusted odds ratio (OR) was 3.89 (95% CI: 1.68, 9.02). Similar results were found using stratification analysis and sensitivity analysis. Male gender and age over 36 months, as covariates in multiple logistic regression models, were also associated with CALs progression. CONCLUSION Low ALB level is identified as an independent risk factor for CALs progression in KD patients. Male gender and age over 36 months are also proved to be risk factors for CALs progression. Further investments are required to explore its mechanisms.
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Affiliation(s)
- Yuhan Xia
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Huixian Qiu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Zhengwang Wen
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Hongying Shi
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China.,Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Huan Yu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Jie Li
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Qihao Zhang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Jianjie Wang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Xing Rong
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Rongzhou Wu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
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Lin SY, He L, Xie LP, Wang Y, Lin YX, Cao YY, Yan WL, Liu F, Huang GY. Effects of immunoglobulin plus prednisolone in reducing coronary artery lesions in patients with Kawasaki disease: study protocol for a phase III multicenter, open-label, blinded-endpoints randomized controlled trial. Trials 2021; 22:898. [PMID: 34895290 PMCID: PMC8665612 DOI: 10.1186/s13063-021-05807-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis of unclear etiology that mainly affects infants and young children. Strategies to reduce the incidence and severity of coronary artery lesions (CALs), the determinant factor in the long-term prognosis of KD, are currently a focus of studies on KD. Corticosteroids, preferred in the treatment of the majority of vasculitides, are controversial in the treatment of acute KD. In this trial, we will evaluate whether the addition of prednisolone to standard intravenous immunoglobulin (IVIG) plus aspirin therapy can reduce the occurrence of CAL in Chinese patients with KD. Methods This is a multicenter, prospective, open-label, randomized controlled trial, which is expected to be conducted in more than 20 hospitals in China and aims to assess the efficacy and safety of IVIG + prednisolone treatment versus standard treatment. Patients with KD who fulfill the inclusion and exclusion criteria will be recruited and randomized (1:1) to receive either a large dose of IVIG (2 g/kg over 12–24 h with a maximum dose of 60 g) + aspirin 30 mg/kg/d or IVIG (2 g/kg over 12–24 h) + aspirin 30 mg/kg/d + prednisolone (2 mg/kg/d with a maximum dose of 60 mg tapered over 15 days after normalization of C-reactive protein concentration). The primary outcome will be the occurrence of CAL at 1 month of illness. The follow-up duration for each participant will be set as 1 year. Patients and treating physicians will be unmasked to group allocation. Discussion This will be the first multicenter randomized controlled trial to evaluate the efficacy of IVIG + aspirin + prednisolone in Chinese pediatric patients with KD, which may provide high-level evidence for improving the initial treatment for acute KD. Trial registration ClinicalTrials.govNCT04078568. Registered on 16 August 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05807-3.
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Affiliation(s)
- Si-Yuan Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Lan He
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Li-Ping Xie
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yin Wang
- Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yi-Xiang Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yin-Yin Cao
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Wei-Li Yan
- Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, 201102, China.
| | - Fang Liu
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
| | - Guo-Ying Huang
- Heart Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
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Cao L, Tang YJ, Gang M, Ma J, Qian WG, Xu QQ, Lv HT. AST-to-ALT ratio and coronary artery lesions among patients with Kawasaki disease. World J Pediatr 2021; 17:659-668. [PMID: 34792780 DOI: 10.1007/s12519-021-00479-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to explore the associations between the aspartate aminotransferase-to-alanine aminotransferase ratio (AST/ALT) and coronary artery lesions (CALs) among patients with Kawasaki disease (KD). METHODS Medical records of KD patients presenting to a single center between January 2019 and December 2020 were retrospectively collected and analyzed. Univariate, multivariable-adjusted analyses, subgroup analyses, restricted cubic spline test, and fitted curves were used to evaluate the associations between AST/ALT and CALs. RESULTS A total of 831 patients were enrolled, of which 201 (24.2%) had CALs on admission and 21 (2.5%) developed CALs de novo after intravenous immunoglobulin (IVIG). Multivariable-adjusted analyses models revealed that a lower AST/ALT was associated with an increased risk of CALs on admission when AST/ALT was a continuous variable (P = 0.007) and when it was a categorical variable (P for trend = 0.004). Each unit increase in AST/ALT was associated with a 22% lower risk of CALs on admission (odds ratio = 0.78, 95% confidence interval 0.65-0.94). A negative linear relationship was noted between AST/ALT and the risk of CALs on admission in both observed and fitted models. However, such associations were not observed in AST/ALT and CALs de novo after IVIG. None of the variables significantly modified the association between AST/ALT and CALs on admission and CALs de novo after IVIG (P > 0.05). CONCLUSION Our findings suggested that AST/ALT was a risk factor of CALs, but was not associated with progressive CALs.
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Affiliation(s)
- Lei Cao
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China
| | - Yun-Jia Tang
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China
| | - Miao Gang
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China
| | - Jin Ma
- Department of Pharmacy, Children's Hospital of Soochow University, No 92, Zhongnan Street, Suzhou, China
| | - Wei-Guo Qian
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China
| | - Qiu-Qin Xu
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China
| | - Hai-Tao Lv
- Department of Cardiology, Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China.
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Mat Bah MN, Alias EY, Razak H, Sapian MH, Foo FH, Abdullah N. Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country. Eur J Pediatr 2021; 180:2599-2606. [PMID: 34086103 DOI: 10.1007/s00431-021-04135-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms. What is Known: • Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population. • Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms. What is New: • In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities. • Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia.
| | - Emieliyuza Yusnita Alias
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Hasliza Razak
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Fang Han Foo
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
| | - Nisah Abdullah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia
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He L, Liu F, Yan W, Huang M, Huang M, Xie L, Guo Y, Xu X, Chu C, Wu L, Liang X, Sun S, Wang F, Zhao L, Zhao Q, Ma X, Xie L, Huang G. Randomized trial of different initial intravenous immunoglobulin regimens in Kawasaki disease. Pediatr Int 2021; 63:757-763. [PMID: 33600060 PMCID: PMC8362187 DOI: 10.1111/ped.14656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND We aimed to assess the efficacy of different initial intravenous immunoglobulin (IVIG) regimens in Kawasaki disease (KD) patients to find more cost-effective therapy options. METHODS A multicenter, open-label, blind-endpoint randomized controlled trial was conducted from January 2014 to December 2015. Patients with KD, within 10 days of illness, were randomly assigned to receive different IVIG regimens (Group A, 2 g/kg once; Group B, 1 g/kg for 2 consecutive days; Group C, 1 g/kg once) and aspirin 30mg/kg/d. Primary outcomes included hours to defervescence and development of coronary artery lesions during the study period. Major secondary outcomes included total fever days, total dose of IVIG, changes of laboratory data, length of stay, and hospitalization expenses. (ClinicalTrials.gov: NCT02439996). RESULTS A total of 404 patients underwent randomization. No difference was found in the outcomes of defervescence among three groups at 6, 12, 24, and 36 hours after completion of initial IVIG infusion. There were no differences in the incidence of coronary artery lesions during the study period (at week 2, month 1, month 3, and month 6 of illness), changes of laboratory data, total fever days, and length of stay. Group C patients had the lowest total dose of IVIG (mean: 1.2 vs 2.2 vs 2.1 g/kg; P < 0.001) and hospitalization expenses (mean: 8443.8 vs 10798.4 vs 11011.4 Chinese Yuan; P < 0.001) than other two groups. CONCLUSIONS A single dose of 1g/kg IVIG is a low-cost treatment with the same efficacy as 2 g/kg IVIG and can be an option for the initial therapy of KD patients.
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Affiliation(s)
- Lan He
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Fang Liu
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Min Huang
- Cardiovascular Department, Shanghai Children's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Meirong Huang
- Cardiovascular Department, Shanghai Children's Medical Center of Shanghai Jiaotong University, Shanghai, China
| | - Lijian Xie
- Cardiovascular Department, Shanghai Children's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Ying Guo
- Cardiovascular Department, Shanghai Children's Medical Center of Shanghai Jiaotong University, Shanghai, China
| | - Xinyi Xu
- Cardiovascular Department, Shanghai Children's Medical Center of Shanghai Jiaotong University, Shanghai, China
| | - Chen Chu
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lin Wu
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xuecun Liang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Shuna Sun
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Feng Wang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lu Zhao
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Quming Zhao
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaojing Ma
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liping Xie
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guoying Huang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Zhang X, He Y, Shao Y, Hang B, Xu Z, Chu M. Factors affecting the duration of coronary artery lesions in patients with the Kawasaki disease: a retrospective cohort study. Pediatr Rheumatol Online J 2021; 19:96. [PMID: 34174872 PMCID: PMC8236149 DOI: 10.1186/s12969-021-00589-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD). Approximately 9-20% of the patients with KD develop CAL despite receiving regular treatment (intravenous immunoglobulin [IVIG] and aspirin). Some patients develop coronary aneurysms, leading to coronary artery stenosis or thrombosis, resulting in ischaemic heart disease and significantly affect the patients' lives. The purpose of this study was to investigate the factors associated with the duration of CAL in patients with KD. METHODS The data of 464 patients with KD and CAL admitted to the Children's Heart Centre, The Second Affiliated Hospital and Yuying Children's Hospital from 2010 to 2018 were retrospectively analysed. Demographic and clinical information and echocardiographic follow-up data were collected. Kaplan-Meier curves were used to estimate the overall CAL duration, and the log-rank test was used to compare statistical differences. Univariate and multivariate Cox regression models were used to identify variables related to the CAL duration. RESULTS The median CAL duration was 46 days (95% confidence interval: 41-54 days). CALs were observed in 61.5, 41.5, 33.3, 22.3, 10.3, and 7.7% of the patients at 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after the onset of KD, respectively. Univariate Cox regression model showed that sex (p = 0.016), rash symptoms (p = 0.035), delayed IVIG treatment (p = 0.022), CAL type (p < 0.001), degree of CAL (p < 0.001), white blood cell count before IVIG treatment (p = 0.019), and platelet count after IVIG treatment (p = 0.003) were statistically significant factors associated with the overall CAL duration. Multivariable Cox regression showed that delayed IVIG treatment (p = 0.020), multiple dilatations (p < 0.001), a greater degree of dilatation (p < 0.001), and higher platelet count after IVIG treatment (p = 0.007) were positively related to CAL duration. CONCLUSIONS CAL duration was affected by delayed IVIG treatment, type of CAL, degree of CAL, and platelet count after IVIG treatment. These factors should be monitored carefully during the follow-up and management of patients with KD and CAL.
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Affiliation(s)
- Xuting Zhang
- grid.268099.c0000 0001 0348 3990Children’s Heart Center, The Second Affiliated Hospital and Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang, China
| | - Yuee He
- grid.268099.c0000 0001 0348 3990Children’s Heart Center, The Second Affiliated Hospital and Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang, China
| | - Yiping Shao
- grid.268099.c0000 0001 0348 3990Children’s Heart Center, The Second Affiliated Hospital and Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang, China
| | - Biyao Hang
- grid.268099.c0000 0001 0348 3990Children’s Heart Center, The Second Affiliated Hospital and Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang, China
| | - Zhipeng Xu
- grid.268099.c0000 0001 0348 3990Children’s Heart Center, The Second Affiliated Hospital and Yuying Children’s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Banday AZ, Mondal S, Barman P, Sil A, Kumrah R, Vignesh P, Singh S. What Lies Ahead for Young Hearts in the 21 st Century - Is It Double Trouble of Acute Rheumatic Fever and Kawasaki Disease in Developing Countries? Front Cardiovasc Med 2021; 8:694393. [PMID: 34250047 PMCID: PMC8263915 DOI: 10.3389/fcvm.2021.694393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 12/19/2022] Open
Abstract
Rheumatic heart disease (RHD), the principal long-term sequel of acute rheumatic fever (ARF), has been a major contributor to cardiac-related mortality in general population, especially in developing countries. With improvement in health and sanitation facilities across the globe, there has been almost a 50% reduction in mortality rate due to RHD over the last 25 years. However, recent estimates suggest that RHD still results in more than 300,000 deaths annually. In India alone, more than 100,000 deaths occur due to RHD every year (Watkins DA et al., N Engl J Med, 2017). Children and adolescents (aged below 15 years) constitute at least one-fourth of the total population in India. Besides, ARF is, for the most part, a pediatric disorder. The pediatric population, therefore, requires special consideration in developing countries to reduce the burden of RHD. In the developed world, Kawasaki disease (KD) has emerged as the most important cause of acquired heart disease in children. Mirroring global trends over the past two decades, India also has witnessed a surge in the number of cases of KD. Similarly, many regions across the globe classified as “high-risk” for ARF have witnessed an increasing trend in the incidence of KD. This translates to a double challenge faced by pediatric health care providers in improving cardiac outcomes of children affected with ARF or KD. We highlight this predicament by reviewing the incidence trends of ARF and KD over the last 50 years in ARF “high-risk” regions.
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Affiliation(s)
- Aaqib Zaffar Banday
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjib Mondal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Archan Sil
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajni Kumrah
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Alghamdi KT, Waggass RA, Aga SS, Alrohaili AA, Alaidroos AH, Alghamdi MD, Algamdi MK, Alghamdi AT. The Most Common Clinical Features of Kawasaki Disease Patients in King Abdulaziz Medical City. Cureus 2021; 13:e15127. [PMID: 34159029 PMCID: PMC8212913 DOI: 10.7759/cureus.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute idiopathic vasculitis affecting the small and medium-sized arteries especially coronary artery (CA). it occurs in childhood mostly below five years of age. Objective This study aims to identify the most common clinical features among KD patients in King Abdulaziz Medical City in Jeddah, Saudi Arabia from 1/1/1982 to 31/12/2018. Methods A case series study was conducted in all KD patients that were admitted to the King Abdulaziz Medical City from 1/1/1982 to 31/12/2018 except those who were diagnosed in other hospitals or whose diagnosis has later changed. The identification of patient was done by using the International Classification of Diseases (ICD) coding for KD (ICD9 446.1). Our data consisted of the patient’s file number, age at presentation, gender, whether the patients received IVIG treatment or not, number of days of fever before starting IVIG treatment, response to IVIG treatment, season in which the symptoms started and clinical features based on body’s system. Result The study included 18 patients, 11 males showed that (55.6%) of patients met the criteria of typical KD and most of them were less than five years old. In addition, most patients were reported to have polymorphous rash, cough, irritability, vomiting, and a murmur. All patients who received intravenous immunoglobulin (IVIG) treatment which demonstrated an improvement even though those who started the treatment after 10 days of fever. Conclusion In typical KD patients, the distribution of the clinical features was almost identical. However, there were some variations in them among atypical KD patients. Moreover, Evan though KD in our region is not common as in Japan, the incidence of giant aneurism was higher. In addition to that, this study and other study conducted in Saudi Arabia found that screened patients reported tachycardia more than patients in Japan. Recommendation As KD is still idiopathic, we recommend more details to be collected from the patients, especially consanguinity as it is common in Saudi Arabia
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Affiliation(s)
- Khalid Talal Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | | | - Syed Sameer Aga
- Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Abdulaziz Ahmed Alrohaili
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Ali Hassan Alaidroos
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Dakhilallah Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Mohannd Khalid Algamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
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Li T, Feng J, Li N, Liu T. Correct identification of incomplete Kawasaki disease. J Int Med Res 2021; 49:3000605211001712. [PMID: 33784852 PMCID: PMC8020237 DOI: 10.1177/03000605211001712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Incomplete Kawasaki disease (IKD) is characterized by a longer fever
time, younger age of onset, and higher incidence of coronary artery
disease compared with complete Kawasaki disease. Kawasaki disease is
often difficult to diagnose early because of its incomplete clinical
symptoms. This issue could delay treatment and harm the health of the
child. This article reviews the clinical characteristics and
pathogenesis of IKD to help clinicians understand the symptoms of IKD,
make the correct diagnosis, and provide timely treatment.
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Affiliation(s)
- Tianhua Li
- Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Jie Feng
- Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Na Li
- Department of Paediatrics, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Tingting Liu
- Department of Ultrasound, Weifang People's Hospital, Weifang City, Shandong Province, China
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